Provider Demographics
NPI:1588831200
Name:ANISH, SUSAN E (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:ANISH
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7658 W FARRAGUT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-1704
Mailing Address - Country:US
Mailing Address - Phone:773-467-0063
Mailing Address - Fax:
Practice Address - Street 1:7658 W FARRAGUT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1704
Practice Address - Country:US
Practice Address - Phone:773-467-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633987OtherBLUE CROSS/BLUE SHIELD NUMBER